Business Analyst – Healthcare Claims & HIPAA (Remote)
We are looking for an experienced Business Analyst with strong US Health Insurance domain expertise to support the implementation and enhancement of a Claims Management Platform while ensuring HIPAA compliance and regulatory alignment.
✅ Must-Have Skills:
✔ 10+ years of Business Analysis experience
✔ 8+ years in US Health Insurance Domain
✔ Strong experience with Enrollment, Eligibility, Prior Authorization, Claims, Payments & Denials
✔ Experience implementing Phase I & II of Claims Management Platforms
✔ HIPAA compliance and healthcare regulatory requirements
✔ BRDs, FRS, User Stories, Acceptance Criteria & Process Flows
✔ Stakeholder Management, Workshops & UAT Facilitation
✔ Agile/Scrum, Jira, Azure DevOps
✔ Data Governance, Data Quality & Audit Compliance
✔ Exposure to Microsoft Fabric
✔ Power BI Reporting & Analytics
✔ Vendor Integration, SFTP & Secure Data Exchange
🔹 Key Responsibilities:
• Gather, analyze, and document business requirements
• Translate business and regulatory requirements into functional specifications
• Facilitate stakeholder workshops and UAT sessions
• Define validation rules, governance requirements, and audit controls
• Collaborate with business, development, QA, and project teams
• Support reporting, analytics, and compliance initiatives
✅ Must-Have Skills:
✔ 10+ years of Business Analysis experience
✔ 8+ years in US Health Insurance Domain
✔ Strong experience with Enrollment, Eligibility, Prior Authorization, Claims, Payments & Denials
✔ Experience implementing Phase I & II of Claims Management Platforms
✔ HIPAA compliance and healthcare regulatory requirements
✔ BRDs, FRS, User Stories, Acceptance Criteria & Process Flows
✔ Stakeholder Management, Workshops & UAT Facilitation
✔ Agile/Scrum, Jira, Azure DevOps
✔ Data Governance, Data Quality & Audit Compliance
✔ Exposure to Microsoft Fabric
✔ Power BI Reporting & Analytics
✔ Vendor Integration, SFTP & Secure Data Exchange
🔹 Key Responsibilities:
• Gather, analyze, and document business requirements
• Translate business and regulatory requirements into functional specifications
• Facilitate stakeholder workshops and UAT sessions
• Define validation rules, governance requirements, and audit controls
• Collaborate with business, development, QA, and project teams
• Support reporting, analytics, and compliance initiatives